Cognitive Behavioral Therapy Group Activities | CBT Therapist Aid

Foreign. The 2021 Wellness Retreat is an opportunity for clinicians and non clinicians to enjoy fall in Tennessee and maybe even a leaf change while you take a deep dive into learning about the mind, body connection and strategies for improving your overall well being. Up to 21 CEUs will be available for clinicians, but again, you don't need to be a clinician to attend. The retreat is being held October 20th through 23rd at Cumberland Mountain State park and is limited to 60 people to allow me to have plenty of time to interact with everyone. Go to allce.comwellness to see the detailed schedule and download the registration form. I look forward to seeing you there. I'd like to welcome everybody today's presentation on cognitive behavioral therapy interventions. Specifically, we're talking about group activities. I AM your host, Dr. Donnelly Snipes. In this presentation, we're not going to explore a lot of theory about cognitive behavioral therapy. Instead, we're going to focus on how do we teach this, how do we get this information to participants in a way that's meaningful, in a way that they can learn it. So in general, cognitive behavioral therapy states as as you probably well know, that changing thoughts or cognitions has a direct impact on the physiological response on the body's physical response, which also includes urges and behaviors. When people have that HPA axis activated, that stress response system that triggers their desire to engage in certain behaviors, fight or flee. So our thoughts are directly related to our physical reactions as well as our behaviors. Changing behaviors has a direct response on thoughts and emotional reactions. If when something happens, you react strongly and and negatively, maybe you run or you fight, for example, then you may still perceive that situation as threatening. In in the future, if you are not getting enough sleep, for example, you know know that's one of those big triggers that we've talked about. People who aren't getting enough sleep or who are drinking too much alcohol that will affect the way they react to situations and the way they perceive situations. So we really want to consider the interaction of the mind, body and environment. At its core, cognitive behavioral therapy has the principles of noticing what's going on, being present, mindful in the moment, understanding and addressing thoughts and feelings and behaviors. So once you're mindful of what's going on in the present context, then it's important to help people understand, okay, why am I reacting this way? Why am I having these particular thoughts in this situation and wanting to engage in these particular behaviors? And it's that really comes down to the individual. Yes, they may have experienced something that Triggered a sense of threat that triggered them to want to fight or flee. But why it triggered that reaction in someone is probably going to be different and it's based on their past experiences. So then at that point we need to go back and look at those past experiences and maybe process those, but also help them learn to look at the situation in the present context and be able to get themselves grounded and say, okay, and what is going on right now in this context at this time? Is it actually a threat? Something that that same situation, if it happened to them back when they were six years old, well, that may have been threatening at that point, but at 26, they can, you know, leave the situation a whole lot more effectively. And the reason we're talking about how to communicate it, you can give people books until the cows come home, or you can tell them how to something until the cows come home. But people tend to retain more when they're content. You know, I like to say happy, but you know, a lot of times when we're working with people in group or an individual, happy is something that they're striving towards. So get them to a place where they're content. They're not hating being there. They're engaged, they're not bored, they're not thinking of six other things. And they're using multiple senses and learning styles. They're hearing it, you know, auditory, they're seeing it visually and they're working with it, they're manipulating it kinesthetically. And that can mean, you know, it's not necessarily kinesthetic like using your hands, but taking a situation and flip flopping it around in your mind trying to figure out what to do with it. All of those things can really help somebody get a much greater intensity of a learning experience. So the my favorite group techniques, and not all of these work for every situation, but my favorite group techniques, the beach ball. You get one of those really cheap inflatable beach balls and on each, you know how they have those stripes, the for colors, they're red, they're yellow, they're blue on each stripe. Or you can even put more on it, you can, than just one per stripe. You put discussion prompts and you pass the beach ball around. Whatever discussion prompt is facing up when somebody catches the beach ball is the discussion prompt they need to answer. So if you're doing one, you can have a beach ball for self esteem, you can have a beach ball for cognitive distortions, you can have lots of beach balls. The nice thing about them is that they deflate so they're easy to store. But that keeps things going, it makes things a little bit more interesting. And it can also keep people from feeling like they're being put on the spot. You know, why is it that you asked me that particular question? Well, you know, it was just what happened to be facing up four corners is another one that I talk about a lot. And with that, ideally you would have dry erase boards in all four corners of the room, but you can also use flip chart paper and then just compost it. But you ask a question or you pro propose something and people have the ability to put answers on each corner will have a different part of that question. And people go around in either individually or in cohorts and answer the questions in each of the four corners. And then you bring them back together and you talk about what the ultimate what, what all the answers were. Ultimately it'll make more sense as we talk about it. Television, Television excerpts are also pretty good. You can take things from, you know, common television shows. One show I'm watching right now is called Scorpion and it's about a man who has an extremely high IQ but an extremely low eq. So there are a lot of good examples of communication difficulties in that one, for example. But you can take particular excerpts from television shows and you can show it to people and then you can process that. And that is often a very non threatening way to process a variety of things without having somebody share their stuff immediately. I usually do that the television excerpts first. And then once people feel kind of comfortable with what's going on, then we might start having them share their own examples. You can do skits, you can do something I call Alphabet circles. And, and what this is is you pick something like coping skills and you go around the circle and each person in the circle identifies a coping skill that begins with that letter of the Alphabet. So the first person would give you a coping skill that started with A, the second person with B, the third person with C, and, and just go around the circle as many times as you need to to get through the Alphabet. That encourages them to kind of get creative because, you know, X. And you probably are really difficult to come up with I examples from. But it can be fun and it can also be funny because some of the things that people come up with for those not often used letters can be rather amusing. So even my adult groups don't have a problem with the Alphabet circle. Some of them don't love them, but a lot of them can have fun with the experience. You can gamify and ultimately, kind of what we're doing with all these is try trying to gamify in some way. But you can gamify by doing something like saying this statement and get. Giving them a statement is an example of which cognitive distortion. And the person would. Ideally, the answer would be personalization. So you can use that kind of a question, or you can say name three types of cognitive distortions. It's another type of question in order to gamify it, really the only thing you need to do is have a stack of questions and two teams. The team in control, stays in control until they get a question wrong, and then the other team gets a chance to answer. If they get it right, then they keep control, you know, and you can make up your own rules a little bit, but if you are teaching psychoeducational content, this can be a way to break up the monotony. And so you're not just lecturing. Family Feud and Jeopardy. Are also two other great ways if you're trying to get people to remember lists of things or remember psycho educational material. So it takes some thinking to figure out, how can I take this material and make it into a. Make it into a game, make it into something that's more active. But once you start getting your juices flowing, a lot of times it'll start coming easier. So let's start with functional analysis. In functional analysis, the person is identifying the antecedents or the causes and triggers for their behavior and the consequences, both positive and negative, of their ultimate behavior. What we're looking for are the causes as well as the consequences in the realm of emotional, mental, physical, social, and environmental. So one of the questions you might ask would be give three examples of physical triggers that might prompt your anxiety. And that would be the question. Give three examples of emotional triggers. Give three examples of environmental triggers. You know, for me, we've talked about this a lot. When I am sleep deprived, that's a trigger for me. I know that that is an antecedent. That is something that usually precedes me having a more emotionally reactive day than on the days that I am well rested. Other people, it may be they drank too much caffeine or they're in a certain environment that brings up extra stress. So what we're really looking for is those triggers and those causes, antecedents, whatever you decide you want to call them, that make a person more vulnerable or more predisposed to reacting in a way they don't want to react, then evaluating the consequences again, both positive and negative problem Identification and solving. Now this is sort of a mnemonic device. I couldn't get it all to go together, but the part I'm most interested in is the side part. And if they remember the ce, that's great too. But in problem identification and solving, we want them to stop. You know, that's the first thing. And so we want to ask them, how can you help yourself stop? Practice the pause, whatever you want to call it. They may use self talk, distress tolerance skills, relaxation techniques, you know, have them make a list of things that they can do in order to restrain impulsive reacting. You know, we want them to be able to get into their wise mind and make a choice to act instead of impulsively reacting. So once they've stopped and they've decompressed, you know, using those distress tolerance skills or self talk and, and gotten into their wise mind, we want them to identify the problem. Who did it, who's involved, where did it happen, exactly what happened and why did it happen and why am I feeling this way? You know, so really looking in, investigating it from a curious perspective, what's going on? Why did this trigger this reaction at this time? Develop alternative solutions. You know, what are three thing, three ways I could handle this situation. Explore the short and long term consequences or outcomes of the solutions. So if I choose solution A, what do I think the short and long term consequences are going to be? If I choose B, you know, what are the short and term, long term consequences? Etc and then choose a response. So for example, if Sally is something happened, she has a really bad day, she's triggered, she just feels, you know, overwhelmed at the end of the day. Identify the problem, you know, encourage her to go back through and identify what happened and who was involved that contributed to her feeling overwhelmed and including things that she did that contributed to it. Develop alternative solutions. Well, one of her solutions might be drink a six pack. Another one might be call a friend and go on a walk. Obviously I'm using two very extreme examples, but you know, short and long term consequences. Well, drinking a six pack may make the thoughts of the problem go away briefly and may temporarily help her relax. But does it solve the problem in the long term? And what are the repercussions of drinking a six pack? You know, extra calories, potential weight gain and the anxiety when she starts to sober up. What are the long term consequences? You know, again, drinking is not necessarily the healthiest thing, especially drinking a six pack in one sitting. So what are the long term consequences? And then doing the same thing for that other suggestion, yes, calling a friend and going on a walk may not have the same escape numbing properties that a six pack does, however. So, so the relief may not be as extreme and as rapid in the short term. However, long term it probably helps her develop more effective coping skills, strengthens her relationship with that person, helps her create a solution to whatever the things were that led to her feeling overwhelmed. So after you go through the short and long term consequences, then choose a response and evaluate the outcome. That's the C and the E. So it's important to encourage people to stop so they can get in their wise mind, you know, explore the problem, you know, be involved, explore what's going on and develop alternative solutions and it choose and figure out choosing the one that has the best short and long term outcomes. So another activity you can do when you experience a problem, you know, and you can throw this out to the group and have them answer it, or you can put these questions on that famous beach ball. How can you remember to practice the pause? What techniques can you use to get through the initial adrenaline rush and get into your wise mind? Describe a time you got upset and effectively managed it. Give an example of a time you got upset and it did did not effectively manage it. What is the difference between, between times people effectively manage distress and times they do not? So what you're wanting to do here, if you're doing it as a group, you're wanting to encourage them to listen to what was going on and what was different in the stories of or the accounts of the people who successfully managed their distress versus the people who didn't successfully manage their distress. To help dis give them clues and insights to as to vulnerabilities that might make them more likely to react impulsively and give them clues to possible effective ways of coping with distress in the future. For example, if they are in a disagreement with their significant other, having a predetermined time set, you know, if they need time out, if they need to take a timeout, having a hand motion, having something and a predetermined time set so they can go and get that time out and the other person doesn't feel like they're being abandoned, the other person knows that, okay, Sally's going to come back in 15 minutes and we can talk. She just needs time to regroup. So there are a lot of different things that you can pull out of these stories. When I do this as a group, I keep track on a pad because, you know, it just helps me remember the different things that people say that when they're answering the questions about the time they got effectively managed distress versus ineffectively managed distress. And I jot down keywords that I'm hearing. So when we get down to this third question or when that third question comes up, I have prompts that I can give people if they have difficulty coming up with something, practice identifying the problem. You can do this with the four corners. So you can give them an example problem or you can use a television show and they watch it and so they kind of know what's going on and they have the background information. And then in each of the corners, I guess this one is five corners, the first one who is involved and obviously the first person you're going to say think of is the person who was, for example, angry and the person that they were yelling at. So that would be who is involved. But there may be other people involved that contributed to the situation. So encourage them to think broadly about what may be going on, what happened, you know, and each person on that what happened corner will add to the description of what they saw and heard happening. And if there is disagreement about what was seen or heard, then that can be noted and discussed at a later time. Because people's perceptions of situations are very different. So you can have, sometimes you'll have two or maybe three different descriptions of what happened based on people's perceptions. But you know, ideally you want to take all three of those and process them and try to create one that is rich and multi, multi dimensional and makes sense to most people. So you're taking those transparencies, if you will, and overlaying them on each other to get a three dimensional picture. When did it take place in the chain of events? You know, what was going on with that person at that point in time? You know, maybe they had had a really bad day and they got pulled over and they were late for work and then they yelled at their co worker. Okay, so that came at the end of a long chain of events. So you're going to identify the events that are leading up to it. Where did it take place and is there a significance to this place? Sometimes people find certain situations more stressful than others. So if something took place at work, they may react much differently than if it happened at home or if it took place at their family home where they grew up. And they have a lot of bad memories. You know, that may be one of those contributors to why they reacted as strongly as they did because they were already experiencing some level of subconscious distress. And then why did it happen whatever it was that happened and why did it bother you? Explore it broadly. So you can do this as a four corners or you can just do it as an individual situation and have somebody describe what happened to, to the group and then have the group ask questions, the who, what, when, where, why questions in order to get more information and get a broader picture of what was happening, to try to peel back some of those blind spots. Obviously there are rules so the person who is sharing doesn't feel like they're on the spot. They have the ability to always say, that's not something I'm comfortable answering. You know, cool. We want to make sure that they feel like they are totally empowered in this and everybody else is like a team of detectives that's trying to help them process this situation and see things that they may not have seen. And then you move on to identifying alternatives once you've identified the problem. Identifying alternatives, the immediate response in the situation, what are the benefits and drawbacks? And then the long term responses, what are the benefits and drawbacks? So maybe somebody got into a disagreement with their co worker and their immediate response was to walk away from the situation. Well, okay, what are the benefits and drawbacks to that? You know, what, what was, what happened and what are the benefits and drawbacks to removing yourself when you know that you are, you know, riled up? Long term responses, what can you do? You know, that was the immediate response. You gave yourself space so you could cool down, get into your wise mind. Now what are the long term responses? If this co worker is constantly, you know, doing something that triggers you, maybe not doing their job or leaving a messy desk or whatever it is, what is the long term response to this situation? To try to solve it. So helping people recognize that sometimes problem solving is a two step process. The immediate response is getting safe and getting in their wise mind. And the long term response hopefully starts addressing the situation so it happens less and so they have better tools to deal with it contracting. Now this one can be fun in terms of Family Feud to come up with some of your response options, if you will. Identifying a target behavior and identifying a new behavior to replace it. So five people were asked about anger management problems or a hundred people were asked about anger management problems. Give me five new behaviors that they identified to replace yelling at someone. Okay, so that would be the top five answers were and you can do the same thing for rewards. You know, what are the top five rewards that people would want to receive if they choose a behavior? Choose something other than yelling. At the other person. So that gives people a way, in a fun way to brainstorm new response options, as well as ways that they can reward themselves for engaging in that new response option. So it can be fun. And then from there, you take all that data and you help people write contracts to monitor their own behavior, whatever that problem or target behavior is. And you may, in your group, you may go through multiple target behaviors and then have people identify and write contracts for themselves on particular behaviors that are most meaningful to them in the moment. Another one for target behaviors, Another family feud. What, for example, what are the five antecedents or triggers for persistent worrying? Persistent worrying, not getting out of bed, anger outbursts, smoking, stress eating and caving or being overly passive. Those are six behaviors, six issues that often come up when with people that I work with in group. So, you know, those are the ones that I would start with unless they bring to the group a particular target behavior that they want to focus on. So identifying you would go through each one. What are the top five antecedents that trigger not getting out of bed? What are the top five antecedents that may trigger anger outbursts? Yada, yada. Identify the benefits and drawbacks of each target behavior. So the 100 people were surveyed, what are the top five benefits of persistent worrying? And then what are the top five drawbacks of persistent worrying? And so obviously it takes a while to get through this, but just like with Family Feud, you can let the each group get together and talk amongst themselves to try to come up with an answer. And it encourages, again, discussion and brainstorming. And it's just, it shakes it up a little bit. Cognitive distortions, when people personalize, they take everything personally. They feel it's like their fault, that it was meant to hurt them. So we want to help people start identifying their cognitive distortions and developing alternative statements. So one of the things that you might do if you use the beach ball for the cognitive distortions is put a on each place on the. On the beach ball. Write down each type of cognitive distortion. And when people look at the beach ball, if it says personalization, for example, then they need to explain what personalization is. Give an example of personalization either that they've used or that they can think of. And then give an example of an alternative statement that counters that. So if something happened at work and the boss was walking down the, down the hall and scowled at you and you took it personally, and you said, you know, the boss is in a bad mood, I must have done something wrong. That's personalization. A contrary statement or an alternative statement would be the boss is in a bad mood. I wonder what might have happened. Because you don't know what happened. You don't know unless you do know it's something you did. But most of the time you don't know that it's something that you did at all. The boss may not have even seen you that they were so caught up in their own thoughts. Exaggeration is making a mountain out of a molehill or seeing the worst case scenario. So this is, you know, kind of a fun one sometimes because I encourage people to play it out all the way to the end. And I have a friend who was going through a time right after he retired and he was, you know, really struggling. He was trying to find another job. He retired from the military, so he was still pretty young. And he was struggling finding a new job. And in his head had played out the tape to the point that he was homeless, penniless and addicted to opioids. Living under a bridge and I'm like scratching my head going, okay, how did we get from point A to point B? And encouraging him to look at that statement, recognize it for what it was, it was his fear, and then identify the probable scenarios was one of the strategies that was helpful for him. All or nothing thinking, viewing things in dichotomous terms. So if somebody says something is always good or never happens, they would restate it in a term it by saying, you know, this often happens or it seems like this rarely happens. You know, instead of saying you never clean the litter box, saying it, you rarely clean the litter box. That's probably more accurate. The availability heuristic is noticing what's most prominent in your mind. So if you think that flying on an airplane is dangerous, that may be the statement, but con countering it with facts and you always want to come back to the facts. So encouraging people to say it feels like or I think that flying is dangerous because of a story I saw on tv, but I don't know all of the facts about it. You know, it takes a little bit of time to figure out what the most effective restatements are. You can also have them identify solutions like for personalization, identify three alternatives or why else might the boss have been, you know, having a grumpy look on their face for exaggeration? Stating three more moderate potential outcomes, all or nothing thinking. Choosing more moderate words like sometimes or often. Availability Heuristic goes back to always noticing what are the facts. You know, I can emotionally reason, you know, I see a snake, I get scared. I think, oh, my gosh, that's dangerous. But that's emotional reasoning that's not based in facts. Because when you look at the facts, you realize that the majority of snakes really aren't that dangerous. Minimization can mean not giving credit where credit is due. When a lot of our clients minimize their accomplishments. And so when they do something, they don't give themselves credit for it. And it's important for them to look at the facts and take credit for it. If they do something that is, you know, notable, recognizing that, hey, I would give somebody else credit for doing this, so I deserve to give myself credit. And when other factors involved are involved, a lot of times people will minimize it. They will overestimate their responsibility in a situation, um, so encouraging them to, again, look at the facts. What percentage of this did you actually contribute? Was it 100% your fault? Was it 80% your fault? Was it 50% your fault? I mean, obviously there's no way to give an exact number, but it's important for people to start getting things into a better perspective so they don't beat themselves up over things that were not entirely their fault. And then selective abstraction is seeing only what fits your mood or perspective. If you're in a bad mood, you're going to notice the negative things. You're going to notice the clouds instead of the sunshine. You're going to notice the roadkill instead of the bunny hopping across the field. So the response to selective abstraction is mindfulness and noticing the good and the bad. Over 10,000 people come to BetterHelp every day looking for a counselor. Better Help makes it easy for you to move your practice online and focus on what you love most, helping others. Better Help's easy to use platform, takes care of referrals and billing, and provides a secured platform to communicate with your clients. Join more than 18,000 therapists at better Help helping to improve people's mental health and lives. Activities to teach cognitive distortion processing. Have people give an example when they've used each cognitive distortion again, that goes back to that beach ball. Or you can put the distortions up on whiteboards or flip chart paper around the room and, and have people give examples of that distortion, how they've used that distortion in the past, discuss why each distortion may develop, and they can again, they can do it going around the room. They can do it in just sitting, you know, sitting there like a normal discussion would happen. I like doing these things in cohorts where people go around. If I have a group of 16. I break it up into four groups of four so people can talk amongst themselves and prompt each other, explore the benefits and drawbacks of each distortion. So that's going to be another section on that whiteboard that day. What are the benefits to it? What are the drawbacks? And then identify ways to address each distortion. So on the whiteboard at the top, you're going to have the label for the distortion, like personalization. Then you're going to have a section where they can fill in by giving an example of when they've used that distortion. Then you're going to have another section where they can discuss why each distortion may develop. How, how does that happen? Then you'll have yet another section where they explore the benefits and the drawbacks on the left and the right. And then the final section at the bottom would be to identify ways to address each distortion. The reason I like doing it in groups is because when people are up, when they're moving around, when they're answering these questions, instead of just sitting there, you know, expecting somebody else to raise their hand, they're more engaged. And that engagement, that persistent engagement through the entire class period or group period tends to promote stronger learning and retention. The ABCDEs, you know, that's Cognitive Behavioral Therapy 101. The activating event, the consequences, and the automatic beliefs that prompted that, those consequences. Going back and disputing the automatic beliefs and then evaluating the effectiveness of their reactions for activities. You can have them identify three things that trigger anxiety. And you can have other things you can do. You can even have them, you know, fill out worksheets on themselves while you're going through, while you're going through the group. If you don't want people up moving around, that's another thing they can do. So some examples of things that trigger anxiety may be bridges, tunnels, authority figures, tests, particular relatives coming to visit. Do the same thing for anger. You know, what things trigger your anger. And I usually have people identify three things that trigger it for them. And then, you know, a lot of times when, when we're doing these two questions, I'll just fill the whiteboard with whatever they're saying. We have a bunch of stream of thought going in order to get everybody's ideas up there. People often find that they have similar triggers for their anxiety and their anger, or they have similar triggers for their anxiety. And they'll also find that all of everybody in the group or most people in the group have similar things that trigger their anger. Once we have those things up there, you know, Then I will ask them to identify one of the triggers and go through and hypothesize about the activating event. Well, whatever that was, the trip, the trigger, the automatic beliefs that would have led to them getting angry or anxious. And I write all of those up on the board as we're going through. And then we go back and dispute those automatic beliefs, recognizing that some of those beliefs are going to be spot on. They may not be able to do anything about them, but they're spot on. So if they, somebody's tailgating them, for example, and they have a thought that this person is rude and has, you know, no concern for other people's safety, well, that could be spot on. That may be true, but they aren't going to be able to change that person's behavior. So we do want to recognize that there are some automatic beliefs that can trigger anger that are very, very accurate. Then we go down to e. Evaluate the effectiveness of the reactions. Well, I have one friend, when she gets tailgated, her reaction because she feels like it's her job in some way to minimize the threat to others and teach this person that they're, you know, being, you know, unsafe, she will slow down five miles an hour below the speed limit and do her best to try to block that person. Now, is that an effective reaction? And, and we talk about this in group, you know, is that an effective reaction? What's probably going to happen? Is it going to make that person go, oh, oops, I'm not being safe, and then suddenly drive safely? Probably not. Is it putting her in more danger? Yeah, probably so. So what would be a more effective reaction? You can start out some of these discussions with examples from, you know, that are unrelated to the people in the group, just to kind of get their, again, get their juices flowing, get them more comfortable being a little bit vulnerable and sharing some of their stuff like those automatic beliefs. Cognitive restructuring is literally changing your thoughts by finding meaning in the current event, challenging your interpretation of event or, and developing a both and perspective, recognizing that, for example, I can be in pain and, and have a very good day, you know, it. I don't have to be in pain and miserable and dwelling on it all day long. Examples of restructuring. So you're going to have people give examples of each of these threats and then we're going to talk about how to restructure it. So threat versus challenge, you know, if you can see something as threatening, like going to an interview or public speaking, or you can view it as a challenge, how can I hit this out of the park. Failure versus a learning experience. You know, relationships don't work out. You can see that as a failure or you can see it as a learning experience. You see where I'm going with this? Loss versus opportunity. You lose a job. Is that a job loss or an opportunity to find a, an occupation that is fits you better and that's more in tune with you. Powerlessness versus empowered. And for this one, forgiveness is one we talk about sometimes because I communicate to them when we talk about forgiveness and other groups that forgiveness is a power, power move. Forgiveness is choosing to not continue to give your energy to that particular situation or to that particular person. You are learning from it, learning how to keep yourself safe from it in the future and then using your energy to continue to keep yourself safe instead of dwelling on what happened that can't be changed. But there are a lot of other things that you can do here. Chronic illness is another one that falls in this category. You can feel powerless over that chronic illness or you can feel empowered to try to figure out what things you can do that mitigate your symptoms and that prevent flare ups and that help you deal with flare ups when they happen. An activity to help people learn this. Identify three common triggers for anxiety or anger. Help people find meaning in that current event. So if you're in a situation that is prompting your anxiety, you don't know if you're going to get a particular job. How can you find meaning in that? How can that maybe make you stronger? How can that help strengthen your coping skills? How can you interpret the event as a challenge instead of a threat and develop a both and perspective? I can be anxious about going in for this interview and still knock it out of the park. Other examples that I've used in this activity, if a significant other doesn't respond to a text, you know, what are some other possible meanings for that, you know, explanations for what's going on? How can that be interpreted as a both and this person loves me and they're not responding to my text? Well, again, there could be a lot of reasons. Maybe their phone's dead, maybe they're, you know, in a dead zone. Who knows? Systematic desensitization is learning to effectively use coping skills to reduce distress through gradual exposure. Level one, imagine and describe the distressing event. Level two, expose yourself at a safe distance to the distressing event. And level three is experiencing the distressing event. For each level, people rate their distress on a scale of 1 to 5. Then they use their skills of choice to reduce their stress. Until they're at a 1. They need to practice it until they can think about the event without getting distressed. So let's take spiders for example. A lot of people don't like spiders. Imagine and describe this distressing event. You know, seeing a spider, being around a spider. Tell me what that's like. And we want people to get to the point where they can describe that event and not start feeling anxious and distressed. They realize they are just talking about something, they're not experiencing it. There actually is no threat. Level two, exposing themselves at a safe distance to the distressing event that can be through virtual reality, that can be watching a video of it on, on the computer or on television or even going outside where they know that at any point there's probably a spider somewhere around. I think the stat says at any point there, there's always a spider within at least six feet of you or something. So thinking about that and just gradually developing the skills to reduce their distress and feel more comfortable until they're at a one. And then level three is actually experiencing that event being face to face. I guess they have faces with a spider and, and talking about how they feel. Obviously you would start with something that is like in a cage and talking about how they feel and talking about the, the different spiders and then maybe watching somebody handling the spider and then eventually maybe progressing to holding the spider themselves. Some people will never get there and there's really not a survival reason that you should ever have to hold a spider. So you know, you want to get to get them to the point where they feel they've reached the maximal gains necessary. And systematic desensitization can be used for a lot of things like public speaking, going on a first date, riding an airplane or something else. And so it's encouraging to others. I, I have found when we do this in group, when somebody says oh, I have this awful fear of public speaking. And three other people say oh yeah, me too. And so I get those people together and I say okay, now let's talk about you guys talk among yourselves about strategies you could use to de escalate your stress so you could get your anxiety down from a five to a one. And then as they're talking about it, they're going to keep talking about it. And I check in on them and say okay, tell me what yalls distress is right now just talking about public speaking. And generally as they start to process and start thinking of coping skills and other things that have to will help them cope with public speaking, their anxiety starts to go down my, my guess is because they're starting to feel more empowered, they're starting to feel like they've got tools to deal with it. Cognitive processing therapy uses analytical questions to help identify cognitive errors and make more effective choices. The basic questions, and every single one of the people that I work with gets this list of questions generally at the beginning, you know, of treatment, because I find that it is extremely helpful. So the first question is, what is the evidence for and against my perception of this situation, my fear, my anger, my whatever. What is the evidence that I should be afraid if I'm anxious? And what is the evidence that says, no, there's nothing to be afraid of? Is this based on facts or feelings? A lot of times if people have already looked for the evidence, then they'll have it before them. And if they're anxious but there's very little in the evidence column to support their anxiety, then they can confidently say, well, apparently my reasoning, my fear of flying, for example, is based on feelings, not facts. Are all of the aspects of the situation being considered? You know, let's stay with flying for this particular one. Certain airplanes are safer than others. You know, if you're flying in a single engine personal aircraft, those tend to have worse safety ratings than your, you know, 727s or 747s, your big commercial jets. So are you considering all aspects of the situation? Another thing people don't consider a lot of times is yes, you know, commercial airliners do crash, but, you know, tens of thousands of flights fly every single day with absolutely no incident. So we want to consider, you know, the probability. Are you using all or nothing terms? Are you confusing high and low probability events, switching over to snakes? You know, when you are out hiking, what is the probability? Assuming you're not like down in the swamp land or something where you might run into a water moccasin, what is the probability that you are going to run into a poisonous snake in your area? So the probability in most areas is that any snakes you see are going to be non venomous. And that would go back to the facts again. Educating yourself. If you're afraid of snakes, learn about snakes. How do you identify the ones that are poisonous? And in most places there's only like a handful of snakes that are actually poisonous. And then finally, what's the most logical course of action? And there are a lot of, you know, different logical courses. But in terms of the snake, you know, if you see a snake and you're like, okay, you know, I don't know if it's poisonous or not, chances are it's not. But the most logical course of action is to give it its space. You know, give it a wide berth and walk around it or back away, whatever you want to do. Not go start poking it with a stick. Identify three things that you're worried about right now. Set for example, not being good enough, failure, or being alone forever. And then go through those questions. What is the evidence for and against your belief that you are not good enough or that you're going to be alone forever? Is this based on facts or feelings? What is the evidence that says you're not good enough? What is the evidence that says you are definitely going to be alone forever? What is the evidence that says that you are good enough? And what's the evidence that there's a good chance you'll find somebody? Are all aspects of the situation being considered? You know, what parts are you looking at? Are you looking at one failed relationship or you know, 15? Are you considering if you think you'll be alone forever? Okay, Are you even trying to go out and meet people? If you're sitting at home watching Netflix every single day, then you know that's probably not helping the situation. Are you using all or nothing terms, confusing high and low probability events? And what is the most logical course of action? If you fear you're not good enough, what would being good enough look like and how could you make that happen? You know, what could you do to improve your self esteem? Basically, if you fear you're going to be alone forever, what do you need to do? Or what is the most logical course of action to help change the the course of that? Acceptance and commitment are two other strategies that we can use. Accepting reality as it is and committing to choosing thoughts and behaviors which will help you move forward toward a rich and meaningful life. Okay, so we are mindful. We accept reality, it is what it is, and we choose to use our energy to move forward instead of staying stuck in the present or struggling with the past. Commitment is a determination to use our energy to improve the next moment and realizing that there are multiple aspects in our life that make it rich and meaningful. So even if one aspect is not going a hundred percent the way we want it, there's probably a lot of other aspects in our life that do make it rich and meaningful in the activity. Have people define a rich and meaningful life. Have them identify their top five values or characteristics that they want to be known for, and you can print off a values worksheet from the Internet that it's Easy to find one, but have people distill it down to their top five. If you want somebody to describe you, what top five adjectives do you want them to use? Which people are important in your life? Which people are unimportant in your life, but you let them have your energy anyway? And what things, hobbies, activities are important in your life and you can do this as an art therapy exercise activity if you want to, or you can do it just as lists. But you know, you want people to really start defining what a rich and meaningful life looks like to them, Then I use the continuum. Moving toward the people, things and experiences that are important or moving away using our energy to move away from those things that are important because we're too busy struggling with the present or stuck in the past we which leads to unhappiness and exhaustion. The questions I ask people and this, this one I generally do on the whiteboard. But you can do it in the four corners. What can you do? Or how can you best address the situation? What thoughts can you have to accept the situation and keep moving forward? What can you do to address this situation that will waste your energy and prevent you move it from moving forward? And what thoughts might you have that will keep you unhappy or prevent you from moving. Oops. Prevent you from moving forward? So encouraging them to break it up into this chambered design, if you will, or chart can help people, especially people who are more analytical, really get a visual depiction of what they're doing and how they want to use their energy. There are a variety of ways to help people explore and address the thoughts that may be keeping them stuck. Some techniques will work better in certain situations. Since cognition is based on prior experiences, teaching cognitive behavioral therapy in group can help clients explore alternate interpretations and information in similar situations. So if two people have gone through breakups, or two people have gotten fired from jobs or whatever the situation is, they probably had different experiences and perceptions. So h hearing about each other's experiences and perceptions can help you get a. Help them get a more robust picture potentially of what might have been going on by helping them uncover some blind spots. By developing a broader understanding of situations, people can explore the effectiveness of their thinking in terms of how it impacts their ability to live a rich and meaningful life. And yes, you know, when you choose, when you print out that value sheet, the ones that I usually I have always selected from, have, have had words on them like dedicated, intelligent, compassionate, you know, those are things that describe the person, not the situation. So when, when using those values, worksheets it really most of them are empowering, family oriented. That's another one because it says, describes how they are, describes how they react, how they are in the moment and interface with the world at large. And encouraging them to do that is really important because you're right, Patricia. It's important to make sure that their values are empowering them to be the person that they want to be. Because once they're the person they want to be, then it's more, and they're accepting of themselves, then it's more likely that they're going to be accepted by others. And no, I have never used these techniques with people with autism. So. And, and since people with autism are such a diverse group, I, I would, would not be comfortable saying that any particular intervention is going to be effective with any particular group of clients with autism. But I'm sure there are ways you can modify them. I just, I have never really sat down to think about that in that situation. I mean, a lot of these group activities do require social interaction, which may be overwhelming to some people with autism.